ABSTRACT
Background: Diabetes mellitus (DM) is a chronic progressive metabolic disorder associated with microvascular and macrovascular complications in type 2 DM. Oral anti-diabetic drugs (OADs) play an important role in regulating raised blood glucose levels and compliance to treatment. Aims and Objectives: The aims of this study were to evaluate cost variations of different brands of drug formulations in the management of DM. Materials and Methods: This study was an analytical study. Costs of various OADs were obtained from January to March 2022 edition of current index of medical specialties India. The cost ratio and percentage of variation among different drugs in the treatment of DM available in Indian Market and Manufactured by different pharmaceutical companies were analyzed. Results: The percentage variation in cost among commonly prescribed single OADs was found to be highest for sulfonylurea group of dugs Glimepiride 1 mg tablet (1.366%), followed by Biguanides, Metformin 500 mg tablet (809%), ?-Glucosidase inhibitors, and Voglibose 0.3 mg tablet (571%), while it was lowest for Glibenclamide 5 mg tablet (36%) and Acarbose 25 mg tablet (36%) of sulfonylurea drugs and ?-Glucosidase inhibitors group of drugs, respectively. In combination drug therapy, Glibenclamide and Metformin combination (1.25 + 250 mg tablet) shows maximum variation (132%). Conclusion: There is a wide difference existing in the cost of various oral anti-diabetics available in Indian Market by different brands. The physicians must be aware of these variations and prescribe medicines accordingly, while considering the financial status of patient and also to promote adherence to treatment.
ABSTRACT
El tratamiento antidiabético oral ha sido un reto en el manejo de la diabetes mellitus. Los pacientes con algún grado de enfermedad renal crónica corren serios riesgos de hipoglucemia, sin embargo, los inhibidores del transportador de glucosa SGLT2 suponen un nuevo abordaje terapéutico de la diabetes mellitus tipo 2. Estudios en modelos experimentales de diabetes han demostrado que la inducción de glucosuria revierte la glucotoxicidad, restaura la normoglucemia, y mejora el funcionamiento de la célula beta y la sensibilidad a la insulina. Por lo tanto, se constituyen en una alternativa segura en estos pacientes.
Oral antidiabetic treatment has been a challenge in the management of diabetes mellitus in patients with some degree of chronic kidney disease due to the constant risks of hypoglycemia; however, glucose transporter SGLT2 inhibitors represent a new therapeutic approach to diabetes mellitus. Type 2, studies in experimental models of diabetes have shown thatthe induction of glycosuria reverses glucotoxicity, restores normoglycemia, and improves beta cell function and insulin sensitivity.
ABSTRACT
Background: Pharmacovigilance is the science which deals with adverse drug reactions (ADRs) appear after long and short drug treatment. ADRs monitoring is essential to gain knowledge of drugs reaction for betterment of mankind. In the present study, observation of ADRs in Type II diabetic patients was conducted in tertiary care hospitals, Bhopal. ADRs reported in the present study were diarrhea, myalgia, flatulence, palpitations, rash, itching, etc., in patients receiving oral hypoglycemic agents. So through this observation, we want to acknowledge the various adverse effects occurred by oral hypoglycemic agents for reduction of morbidity and mortality in Type II Diabetic patients. Aims and Objectives: (1) The objectives of the study were to ADRs monitoring in Type II Diabetic patients receiving oral anti-diabetic agents and (2) to compare ADRs in conventional versus newer anti-diabetic agents therapies in Type II Diabetic patients. Materials and Methods: 150 patients were enrolled for evaluating adverse effects with oral antidiabetic agents. All patients were followed up by medical history, history of drugs, and any severity of ADR. Causality was graded by Naranjo scale. Results: 45 patients (30%) with mean age of 64.6 year (SD = 2.41) complained adverse effects and out of which 17 (11.3%) patients were reported to the physician. The most common adverse effect was found with sulfonylureas, biguanides, and thiazolidinediones such as hypoglycemia, weight gain, gastrointestinal (GI) disturbances allergic reactions, and dizziness probability of adverse effects more common in females (64.17%) in comparison to male (35.29%) patients. Conclusion: In Type II Diabetic patients receiving oral antidiabetic agents provides a fruitful information about a ADRs and enhance knowledge about pharmacovigilance to health-care providers. However, predominance of adverse effects in female diabetic patients was reported. Hypoglycemia, weight gain, and GI tract disturbances were observed frequently with oral antidiabetic agent in middle age diabetic patients. By this information, we can prevent drug related complications and improve quality of life of a person
ABSTRACT
Context: Oral antidiabetic drug (OAD) failure is an indication for starting insulin therapy, but there is still a dilemma as to whether basal insulin or a premixed/co-formulation analog should be the choice. Aim: To compare the safety and efficacy of once daily (OD) insulin degludec/insulin aspart (IDegAsp) to OD insulin glargine (IGlar U100) in insulin-naïve Indian subjects with type 2 diabetes mellitus (T2DM), inadequately controlled with OADs alone. Setting and design: Retrospective study. Methods and material: Data was retrieved from the author’s clinic database of OAD failure patients (18-80 years), who were started either with (IGlar U100, n = 120) or IDegAsp (n = 89) OD over and above the standard of care. Data of fasting plasma glucose (FPG), postprandial plasma glucose (PPG) and glycated hemoglobin (HbA1c) from baseline and at last follow-up visits were collected. Statistical analysis used: Baseline characteristics and change in study parameters during the follow-up period were computed between two groups (IGlar U100 vs. IDegAsp) by unpaired t-test and paired t-test, respectively. ANCOVA test was used to compute percentage reduction in body weight, body mass index (BMI), FPG, PPG and HbA1c in between two groups (IGlar U100 vs. IDegAsp). Results: IDegAsp caused a significantly greater reduction in FPG, PPG and HbA1c as compared to the IGlar U100 arm. There was no significant difference in the proportion of patients with hypoglycemia between IDegAsp and IGlar U100 groups (p = 0.208). No episodes of severe hypoglycemia were reported. Conclusion: Comparison of IDegAsp and IGlar U100 OD in T2DM patients indicated that both were relatively safe but the former controlled FPG and PPG levels more effectively.
ABSTRACT
Background: Medication adherence is a major challenge in treatment of type 2 diabetes. Hence the pre-sent study was undertaken to assess the factors influencing drug adherence in Type 2 diabetes Benga-luru. Methods: A descriptive study was conducted in urban health training centre Bengaluru for a period of 9 months. A total of 70 type 2 Diabetes patients only on oral drugs willing to give informed consent were included. Institutional Ethical Committee clearance was obtained and pre-tested semi structured proforma was administered and the probable factors that affect adherence was included. Data was en-tered in Microsoft excel and analyzed in SPSS-21. Descriptive statistics and inferential statistics like Bi-nary logistic regression was used to assess the factors influencing drugs. Results: Around 92.8% consumed ?2 drugs and consumed single or combination of drugs. Most com-mon anti-diabetic drug consumed was Biguanides in 64(91.4%). Good adherence (0-2 score) to oral anti-diabetic drugs was observed in 43 (61%) study subjects the factor significantly associated with poor ad-herence in Binary Logistic Regression Model is sometimes forgetting to consume the medication. Conclusion: The factors that influenced oral anti-diabetic drugs good adherence is consuming the medi-cations without forgetting. Efforts are needed to improve adherence and self-management techniques to prevent complications.
ABSTRACT
RESUMEN La diabetes mellitus tipo 2 se asocia a un incremento del riesgo de mortalidad por enfermedad cardiovascular y es una afección frecuente dentro de los pacientes con enfermedad cardiovascular establecida. El tratamiento adecuado permite mejorar la calidad de vida del paciente y disminuir la morbilidad y la mortalidad por esta y otras causas. La rehabilitación cardiovascular ha demostrado ser una terapéutica eficaz y beneficiosa en los pacientes con diabetes mellitus tipo 2. Por eso, se revisaron 70 referencias bibliográficas con el objetivo de describir elementos importantes sobre su tratamiento, que incluye estrategias farmacológicas, no farmacológicas y la rehabilitación cardiovascular.
ABSTACT Type 2 diabetes mellitus is associated with an increased risk of mortality from cardiovascular disease and it is a common condition within patients with established cardiovascular disease. Appropriate treatment can improve the patient's quality of life and decrease morbidity and mortality from this and other causes. Cardiovascular rehabilitation has been shown to be an effective and beneficial therapy in patients with type 2 diabetes mellitus. For this reason, 70 bibliographic references were reviewed with the aim of describing important elements of its treatment, which includes pharmacological and non-pharmacological strategies and cardiovascular rehabilitation.
ABSTRACT
O diabetes mellitus gestacional (DMG) é um distúrbio metabólico por déficit na produção e/ou ação insulínica. Tem relação direta com um constante estado catabólico associado com maior resistência à ação da insulina. Doença de difícil controle, implica risco materno-fetal elevado. O objetivo é estudar a eficácia das drogas antidiabéticas orais sobre o controle glicêmico no DMG e sua segurança quanto aos desfechos gestacionais e perinatais. Trata-se de revisão de literatura descritiva baseada em dados de artigos, livros-texto e guidelines emitidos nos últimos cinco anos. O antidiabético oral pode ser uma boa alternativa no controle do DMG em fase inicial da doença, na presença de distúrbio metabólico e como complemento da terapia com insulina. Entretanto, por causa de sua passagem placentária, há preocupações com seus efeitos fetais e perinatais. Estudos comparativos destacam a metformina no manejo do DMG, considerando principalmente a segurança materno-fetal.(AU)
Gestational diabetes mellitus (GDM) is a metabolic disorder caused by deficit in production and/or insulin action. It is directly related to a constant catabolic state associated with greater resistance to insulin action. Disease difficult to control, implies high maternal-fetal risk. To study the efficacy of oral antidiabetic drugs on glycemic control in GDM and its safety regarding gestational and perinatal outcomes. Descriptive literature review based on data from articles, textbooks and guidelines issued in the last five years. Oral antidiabetic can be a good alternative in the control of GDM in the initial phase of the disease, in the presence of metabolic disorder and as a complement to insulin therapy. However, there are concerns about its placental passage and perinatal effects. Comparative studies highlight metformin in the management of DMG considering mainly maternal-fetal safety.(AU)
Subject(s)
Humans , Female , Pregnancy , Pregnancy Complications/drug therapy , Diabetes, Gestational/drug therapy , Diabetes Mellitus/drug therapy , Hypoglycemic Agents/therapeutic use , Administration, Oral , Risk Factors , Glyburide/therapeutic use , Acarbose/therapeutic use , Metformin/therapeutic useABSTRACT
Background: Diabetes mellitus is a chronic disease with a high mortality and morbidity. Knowledge regarding the disease is required for the management of drug adherence in diabetes, hence the present study was taken to assess the effectiveness of health education on knowledge regarding oral anti-diabetic drug adherence.Methods: The study was conducted at urban health training centre of a medical college, Bengaluru from October 2015 to July 2016. A total of 70 type 2 diabetes mellitus patients were involved in this descriptive and interventional study. The study subjects included only on oral anti-diabetic drugs and willing to give informed consent. A pre-tested semi-structured proforma was administered and information about socio-demographic profile, and impact of health education intervention on knowledge was obtained.Results: Most of the subjects were female (80%), in the age group of 35-45 years (34%), illiterate (40%), unemployed (67%) with class IV (78%) socio-economic status according to Modified Kuppuswamy classification 2014. The mean±SD age was 52.47±11.06 years. Significant improvement in knowledge regarding adherence to oral anti-diabetic medication was found in study subjects following health education intervention.Conclusions: The study revealed that health education regarding the importance of drug adherence is needed in study subjects and there was significant improvement in knowledge after health education.
ABSTRACT
Background: The aim was to evaluate the drug utilization pattern of oral antidiabetic drugs in type 2 diabetes mellitus outpatients and monitor adverse drug reactions (ADRs) associated with oral antidiabetic drugs.Methods: A retrospective observational study was carried out by collecting the data of type 2 diabetes mellitus patients visiting outpatient department of noncommunicable disease clinic of a tertiary care hospital for a period of one year. The data of demographic, drug utilization pattern and adverse drug reactions of patients on oral antidiabetic drugs was collected and entered in a proforma.Results: Total number of patients in this study were 39 out of which 21 (53.85%) patients were females and 18 (46.15%) patients were males. Majority of patients were in the age group 51-70 years (66.6%). Metformin was the most commonly prescribed drug 76.9% followed by Glibenclamide 17.9%. About 7.7% of patients who were taking oral antidiabetic drugs later switched over to insulin as their blood glucose levels were not controlled. Out of 18 (46.15%) patients, hypertension (38.5%) was the most common comorbid condition and a concomitant drug was prescribed was amlodipine 25.6%. Among all the adverse drug reactions observed, diarrhoea was the most common adverse drug reaction reported 76.9%.Conclusions: Metformin was the most commonly used oral antidiabetic drug. Diarrhoea was the common adverse drug reaction reported.
ABSTRACT
Background: This comparative study was done to evaluate the change from baseline in HbA1c levels with teneligliptin vs. metformin treatments at week 12 among recently diagnosed type 2 DM patients attending Medicine OPD of Dr. B. C. Roy Hospital, Haldia, West Bengal (a tertiary care teaching hospital).Methods: In this prospective parallel group clinical study patients were divided into two groups. Group A patients were on metformin monotherapy therapy and Group B patients were on teneligliptin monotherapy. Data of 40 patients (20 patients in each group) were available for analysis in the present study. Secondary endpoints included changes from baseline FPG and 2h-PPG values at 12 weeks were evaluated. Safety and tolerability were assessed by the incidence of adverse events (AEs) throughout the study period.Results: The mean age of patients was 50.05±12.35 years and out of the entire patient population 70% were males and 30% were females. At the end of 12 weeks or 3 months of metformin therapy, mean HbA1c, FBG, and PPG were significantly reduced by 0.52%, 16.2mg/dL, and 36.8mg/dL, respectively, and 37.75% of patients achieved the HbA1c target of <7%. At the end of 12 weeks or 3 months of teneligliptin therapy, mean HbA1c, FBG, and PPG were significantly reduced by 0.60%, 19.4mg/dL, and 49.8mg/dL, respectively (Table 2), and 40% of patients achieved the HbA1c target of <7%.Conclusions: Teneligliptin, a DPP4 inhibitor reduced HbA1C significantly compared with monotherapy of metformin in treatment naive patients at week 12. It also reduced FBG and 2-h PPBG as compared with metformin at week 12.
ABSTRACT
One thousand and forty-six patients with type 2 diabetes mellitus (T2DM) aged >18 years from 11 community health service centers in Beijing Chaoyang district were enrolled in the study. The body weight, height, fasting plasma glucose level and glycosylated hemoglobin A1c (HbAlc) were measured. A door-to-door questionnaire survey on the use of oral antidiabetic drugs and insulin was conducted between January to December 2017. Of 1 046 T2DM patients, 182 (17.4%) received lifestyle intervention, 257 (24.6%) used single oral antidiabetic drug (OAD), 326 (31.2%) with combined OAD, and 281(26.9%) with insulin and OAD. The average HbA1c in T2DM patients with lifestyle intervention, single OAD drug, combined OAD, and insulin and OAD were (8.1±2.3)%, (7.6±2.0)%, (7.8±2.0)%, and (8.7±2.1)%, respectively (F=18.35, P<0.01). Proportions of the T2DM patients with HbAlc lower than 7.0% were 45.1%, 55.6%, 43.6% and 36.8% in groups, respectively (χ2=55.55, P<0.01). Patients with single or combined OAD aged 18-<45 years had a worse HbA1c control than those aged 45-<65 years and≥65 years. It was found that 59.4%, 52.6%and 30.8%of the patients receiving one OAD, two OADs and three or more OADs achieved glucose control target. The proportion of drug use was 62.6% for α-glucosidase inhibitors, 50.8% for metfomain, 32.5% for insulin, 18.2% for sulfonylureas, 4.9% for glinides, 3.2% for thiazolidinediones and 3.1% for dipeptidyl peptidase-Ⅳs. Among the combined treatment regimens, metfomain+a-glucosidase inhibitors was the most frequently used as compared with α-glucosidase inhibitors+sulfonylureas and metfomain+sulfonylureas. The survey showed that the target-reaching rate of HbA1c was 44.9%, and α-glucosidase inhibitors were frequently used for patients with T2DM in community health service centers in Beijing Chaoyang district south medical alliance.
ABSTRACT
One thousand and forty-six patients with type 2 diabetes mellitus (T2DM) aged ＞18 years from 11 community health service centers in Beijing Chaoyang district were enrolled in the study.The body weight,height,fasting plasma glucose level and glycosylated hemoglobin A 1c (HbAlc) were measured.A door-to-door questionnaire survey on the use of oral antidiabetic drugs and insulin was conducted between January to December 2017.Of 1 046 T2DM patients,182 (17.4％) received lifestyle intervention,257 (24.6％) used single oral antidiabetic drug (OAD),326 (31.2％) with combined OAD,and 281(26.9％) with insulin and OAD.The average HbA1c in T2DM patients with lifestyle intervention,single OAD drug,combined OAD,and insulin and OAD were (8.1±2.3) ％,(7.6±2.0) ％,(7.8±2.0) ％,and (8.7±2.1) ％,respectively (F=18.35,P＜0.01).Proportions of the T2DM patients with HbAlc lower than 7.0％ were 45.1％,55.6％,43.6％ and 36.8％ in groups,respectively (x2=55.55,P＜0.01).Patients with single or combined OAD aged 18-＜45 years had a worse HbA1c control than those aged 45-＜65 years and≥65 years.It was found that 59.4％,52.6％and 30.8％of the patients receiving one OAD,two OADs and three or more OADs achieved glucose control target.The proportion of drug use was 62.6％ for α-glucosidase inhibitors,50.8％ for metfomain,32.5％ for insulin,18.2％ for sulfonylureas,4.9％ for glinides,3.2％ for thiazolidinediones and 3.1％ for dipeptidyl peptidase-Ⅳs.Among the combined treatment regimens,meffomain+a-glucosidase inhibitors was the most frequently used as compared with α-glucosidase inhibitors + sulfonylureas and metfomain + sulfonylureas.The survey showed that the target-reaching rate of HbA1c was 44.9％,and α-glucosidase inhibitors were frequently used for patients with T2DM in community health service centers in Beijing Chaoyang district south medical alliance.
ABSTRACT
Background: Diabetes Mellitus is a chronic metabolic disorder, one of the major causes of morbidity, mortality and needs lifelong treatment. There are large numbers of oral anti-diabetic drugs available for the treatment of type 2 diabetes mellitus. There are numerous brands available for each of the individual oral anti-diabetic drug. Thus, a study was planned to find out cost variation among different brands of same active oral anti-diabetic drug.Methods: Cost of a particular drug being manufactured by different companies, in the same strength and dosage forms was obtained from the price list provided by the pharmaceutical companies in Current Index of Medical Specialities (CIMS) (October 2017- January 2018). The difference in the maximum and minimum price of the same drug manufactured by different pharmaceutical companies and percentage variation in price was analyzed.Results: Percentage cost variation of the commonly used drugs found was seen highest with Sulfonylureas (Glimepiride - 562%) followed by Metformin (492%) which was followed by Pioglitazone (488%), DPP-4 inhibitor Teneligliptin (231%), α- glucosidase inhibitors (Voglibose 284%), Meglitinides (Repaglinide 0.5mg 154%) and lowest was seen with Repaglinide 2mg (15%).Conclusions: There is very wide cost variation among different brands of the same oral anti-diabetic drugs manufactured in India. The average percentage cost variation of different brands of the same oral anti diabetic drugs manufactured in India is very wide. The appraisal and management of marketing drugs should be directed toward maximizing the benefits of therapy and minimizing negative personal and economic consequences.
ABSTRACT
Background: Prescription pattern studies are a tool for assessing the prescribing, dispensing and distribution of medicines. The main aim of assessing prescribing pattern is to facilitate rational use of medicines. So the main aim of the study was to assess the prescribing pattern of oral anti-diabetic agents in type 2 diabetes mellitus, to assess the rationality of the prescribed drugs and also to assess the pattern of co-morbid conditions associated with type 2 diabetes mellitus in a tertiary care hospital.Methods: This cross sectional study was conducted in the Department of Pharmacology in collaboration with Department of General Medicine. Study was conducted from 1st June 2016 to 31st Aug 2016 (3 months). A total of 100 patients were enrolled after taking written informed consent. A structured case recording form was used to record demographic details and prescription details. The rationality of prescriptions was assessed using American Diabetes Association guidelines 2015.Results: Majority of the patients were prescribed combination therapy (54%) followed by monotherapy (46%). Oral anti-diabetic agents used as monotherapy other than metformin were inappropriate. Among the patients receiving combination therapy majority were receiving a fixed dose combination which were inappropriate.Conclusions: Majority of the patients were receiving fixed dose combinations without justifiable pharmacokinetic/pharmacodynamic benefits. Such kinds of studies are required to improve rationality of prescription of drugs, decreasing morbidity and mortality of patients and decreasing the cost of treatment.
ABSTRACT
Background: Type 2 diabetes mellitus (T2DM) is one of the most common non-communicable diseases associated with ‘atherogenic dyslipidemia’ The treatment of T2DM often is initiated with oral antidiabetic drugs, most of which not only decrease blood sugar levels effectively but also decrease the lipid levels. Hence the current study is aimed to determine the effectiveness of oral hypoglycemic agents in dealing with associated dyslipidemia.Methods: 150 T2DM patients were divided equally into five groups depending upon the oral antidiabetic drugs they received in solo or in combination for 24 weeks, with equal number of males and females in each group. After the written consent, a detail clinical history, clinical examination, Biochemical investigations including, glycosylated haemoglobin and lipid profile, chest X-ray and ECG were done.Results: After 24 weeks of study, the mean total cholesterol and mean triglycerides decreased significantly (p <0.05 to p <0.01) with monotherapy of metformin and teneligliptin as well as with combination of either metformin and glimepiride or metformin and teneligliptin. The decrease of LDL-C and VLDL-C was not statistically significant with any of the OAD drugs in solo or in combination. Similarly, HDL-C increased significantly (p <0.05) in Group I, III, IV and V; but was most effective with combination therapy. The atherogenic index of plasma also decreased (p <0.05) with metformin or its combination with either teneligliptin or glimepiride.Conclusions: Oral antidiabetic drugs are not only affordable and effective hypoglycemic agents but can also decrease serum lipids and thereby aids in the prevention and management of atherosclerosis and its complications in T2DM.
ABSTRACT
Objective: In this study, we surveyed the attitudes of community pharmacists regarding oral antidiabetic drugs that need to be continuously administered, focusing especially on recently available oral‐combination antidiabetic drugs, in terms of their positioning and medication adherence. In addition, we identified relevant problems from the survey results and discussed the proper use of the combination drugs.Methods: We conducted a questionnaire‐based survey on health insurance‐covered dispensing pharmacies belonging to Kanazawa, Koga, Takasaki, Hitachi, and Hitachinaka Pharmaceutical Associations via fax or post from September 1, 2017 to November 30, 2017.Results: The overall response rate to the survey was 29.8%. Although combination drugs were considered useful in terms of improved motivation to take medication, i.e., medication adherence, there were also opinions claiming that combination drugs are not particularly useful due to the following reasons: there are problems in discarding residual drugs, they are less economical than individual drugs, it is difficult to ingest tablets of combination drugs because of their large size, it is difficult to adjust doses of combination drugs, and medication adherence does not change because of concomitant drug use.Conclusion: Based on the results there was the opinion that a combination oral diabetes drug improves medication adherence but problems such as the generation of leftover unused drugs due to switching and an increase in the risk of overuse when taking medication was pointed out. It is necessary for pharmacists to give advice in recognition of the risks with each active ingredient of the oral diabetes combination drug and to continuously monitor any development of side effects. Furthermore, as with other diabetes remedies, pharmacists need to advise regarding the patient's lifestyle as well as monitor laboratory test results such as kidney function. The patient's swallowing ability is also an important consideration at the time of medication instruction.
ABSTRACT
Objective:To evaluate the standardized usage of oral antidiabetic agents in inpatients to provide reference for the pre -scription standardization .Methods:A retrospective study was used to evaluate the prescriptions of oral antidiabetic agents in inpatients during January and March in 2017 , and statistical analysis was conducted on drug usage and standardization evaluation .Results:There were 886 medication plans including 4,397 prescriptions, which involved in 13 kinds of antidiabetic agents .Metformin and acarbose a-gents were used most frequently .The non-standardization rate was 70.54％with 66.03％unlabeled accurate time for oral administra-tion and 4.51％ labeled wrong time for oral administration .Twelve antidiabetic agents existed non-standardized applications ( >50％) .Conclusion:The main problem in the non-standardized usage of antidiabetic agents is leaving the special time for oral adminis -tration of antidiabetic agents out of account , which not only affect the best efficacy , but also reduce patients ' compliance .It' s neces-sary to standardize the prescriptions of antidiabetic agents to improve the standardization of medication therapy .
ABSTRACT
Resumen: ANTECEDENTES: la hipoglucemia grave es causa frecuente de hospitalización en México. OBJETIVO: identificar las características clínicas y de laboratorio asociadas con hipoglucemia grave en pacientes consecutivos con hipoglucemia grave y azoados normales. PACIENTES Y MÉTODO: estudio prospectivo en el que del 11 agosto de 2011 al 31 mayo de 2013 se incluyeron pacientes con hipoglucemia grave y creatinina normal. Se registró edad, sexo, tiempo de evolución de la diabetes mellitus, tratamiento antidiabético, comorbilidades y depuración de creatinina en orina de 24 horas. RESULTADOS: ingresaron 234 pacientes con hipoglucemia grave, 21 9% tenían creatinina normal: 13 mujeres 62% y 8 38% hombres, con edad promedio de 64.76 años límites: 42-84; 13 62% eran mayores de 60 años; 15 71% tenían más de 5 años con diabetes mellitus 2 promedio de evolución de 9.2 años; 15 recibían glibenclamida 71%, 4 en combinación con insulina 19% y 8 con metformina 38%; 2 recibían rosiglitazona más insulina. Cuatro no tenían comorbilidades 19%; 14 tenían hipertensión arterial 71% y 3 neoplasia adenocarcinoma, carcinoma gástrico y carcinoma esofágico; 11 52% ingresaron con pérdida del estado de alerta; 5 con desorientación 24%, 4 con trastornos de conducta 19%, uno con dislalia 5%; 15 de 21 71% tenían grado avanzado de deterioro renal, a pesar de tener azoados normales. CONCLUSIONES: es importante determinar la depuración de creatinina en todos los niveles de atención, única guía para prescribir tratamientos seguros de acuerdo con la función renal. La glibenclamida debe prescribirse con cautela en adultos mayores, con más de 10 años de evolución de la diabetes mellitus 2 y evitarse en los sujetos con insuficiencia renal crónica documentada.
Abstract: BACKGROUND: Severe hypoglycemia is a frequent cause of hospitalization in Mexico. OBJECTIVE: To identify the clinical and laboratory characteristics associated to severe hypoglycemia in consecutive patients with severe hypoglycemia and normal creatinine serum values. PATIENTS AND METHOD: A prospective study was done from August 11, 2011 to May 31, 2013, including patients with severe hypoglycemia and normal creatinine serum values. Age, sex, time of evolution of diabetes mellitus 2, antidiabetic treatment, comorbidities and 24-hour urine creatinine clearance were recorded. RESULTS: From 234 patients with severe hypoglycemia admitted, 21 9% had normal creatinine: 13 women 62% and 8 38% men, with a mean age of 64.76 years range: 42-84; 13 62% were older than 60 years; 15 71% had more than 5 years with DM2 mean evolution of 9.2 years; 15 received glibenclamide 71%, 4 in combination with insulin 19% and 8 with metformin 38%. Two received rosiglitazone plus insulin. Four patients had not comorbidities 19%; 16 had arterial hypertension 71% and 3, neoplasms adenocarcinoma, gastric carcinoma and esophageal carcinoma. Eleven patients 52% were admitted with syncope, 5 with disorientation 24%, 4 with conduct disorders 19% and one with dyslalia 5%; 15 of 21 patients 71% had advanced degrees of renal impairment, despite normal creatinine serum values. CONCLUSIONS: It is important to perform creatinine clearance at all levels of care, the only guide for safe treatments according to kidney function. Glibenclamide should be cautiously prescribed in older adults with a history of more than 10 years of diabetes mellitus 2 and should be avoided in those with documented chronic renal failure.
ABSTRACT
Objective To summarize the current status and trend of hypoglycemic agents of diabetic inpatients in different departments of Chinese PLA General Hospital.Methods The clinical data of diabetic patients admitted to Chinese PLA General Hospital from January 2000 to May 2014 were collected(those hospitalized in the department of endocrinology were excluded).A total of 10 041 patients were selected by stratified random sampling.The type of hypoglycemic agents in different departments and the variation on anti-hyperglycemic drugs with time were retrospectively analyzed.Results Of all the patients in non-endocrinological wards, 50.2% were treated with insulin, 36.9% with metformin, 21.3% with α-glycosidase inhibitor, and 18.9% with sulfonylureas.Metformin, α-glucosidase inhibitors, pre-mixed 30R, and insulin glargine were more commonly used than other anti-hyperglycemic agents, accounting for 36.9%, 21.0%, 14.0%, 8.7%, respectively.Metformin, sulfonylureas, α-glucosidase inhibitor, and different types of insulin were more widely applied in internal medicine while insulin therapy was more frequently used in surgical department.During the past 15 years, the proportions of insulin, glinides, α-glucosidase inhibitor, and thiazolidinediones application were gradually increased, while the proportions of sulfonylureas and metformin treatment were on the decline trend.Conclusion Most of the inpatients were treated with oral antidiabetic drugs.Metformin, α-glucosidase inhibitor, pre-mixed 30R, and insulin glargine were the most frequently prescribed agents for the inpatients.
ABSTRACT
<p>Consultations with patients who bring drugs, especially on the high risk drug list, to a hospital is an important role of pharmacists. However, many incident reports occur though pharmacists generally make an effort to check such medications. In Japan, incidents are mostly reported just in terms of numbers but not in terms of the prevalence of a target group. We aim to reveal the prevalence of incidents related to medicine brought-in by patients undergoing surgery in National Hospital Organization (NHO) hospitals. For our study, we extracted patients undergoing surgery who were prescribed antidiabetic agents from the Medical data bank (MIA) in NHO. Chart reviews were performed on patients to evaluate the number of incidents in relation to brought-in medicine. The prevalence of incidents of interest was 4.4% (41/931, 95%CL : 3.2-5.9%). Pre-avoidable incidents represented 56.1% (23/41, p<0.0001). We found that pharmacists play a role in making incidents less severe.</p>